Radiofrequency ablation using the ThermoCool SmartTouch Catheter guided by ablation index versus antiarrhythmic drugs in atrial fibrillation treatment in China: a cost-consequence analysis.

Aim: To evaluate the costs and consequences of two front-line atrial fibrillation (AF) treatments from Chinese healthcare system perspective: radiofrequency catheter ablation (RFCA) using ThermoCool SmartTouch Catheter guided by Ablation Index (STAI), in comparison to antiarrhythmic drugs (AADs). Patients & methods: We simulated clinical and economic consequences for AF patients initially receiving STAI or AADs using a short-term decision tree model leading to a 10-year long-term Markov model. The model projected both clinical consequences and costs associated with, among others, AF, heart failure (HF), strokes, and deaths due to AF or AF related complications. Data informing the models included combination of a local real-world study and published clinical studies. Results: STAI was advantageous versus AADs on all 4 main clinical outcomes evaluated; AF: 25.83% lower (12.84% vs 38.67%), HF: 2.22% lower (1.33% vs 3.55%), stroke or post stroke: 1.82% lower (10.00% vs 11.82%) and deaths due to AF or AF related complications: 0.64% lower (4.11% vs 4.75%). The average total cost per patient in STAI group was ¥16,682 lower (¥123,124 vs ¥139,806). The one-way sensitivity analysis indicated that the difference in total cost was most sensitive to annual AF recurrence probability in AADs-treated patients. Probabilistic sensitivity analysis indicated a 98.5% probability that RFCA treatment would result in cost savings by the end of the 10th year. Conclusion: Radiofrequency catheter ablation using SmartTouch catheter guided by Ablation Index was superior to AADs as the first-line AF treatment in Chinese setting with better clinical outcomes and at lower costs over a 10-year time horizon.

Assessing the causal relationship between COVID-19 and post-COVID-19 syndrome: A Mendelian randomisation study.

Background: In the aftermath of the coronavirus disease 2019 (COVID-19) pandemic, we sought to explore the causal association between COVID-19 and 17 prevalent post-COVID-19 syndrome (PCS) symptoms using Mendelian randomisation (MR) methodology. Methods: We used 22 extensive genome-wide association study (GWAS) data sets, incorporating genetic variants as instrumental variables. Univariate Mendelian randomisation (UVMR) analyses involved 15 single nucleotide polymorphisms (SNPs) for COVID-19 patients, 33 for hospitalised COVID-19 patients, and 29 for patients with severe respiratory symptoms due to COVID-19. Furthermore, we further used multivariable Mendelian randomisation (MVMR) analyses based on 93 SNPs for COVID-19 patients, 105 for hospitalised COVID-19 patients, and 99 for patients with severe respiratory symptoms due to COVID-19. With these analyses, we aimed to assess the causal associations between varying levels of COVID-19 infection and 17 prevalent PCS symptoms while accounting for the influence of educational and income levels. Results: UVMR analysis identified potential causal effects of COVID-19 genetic susceptibility on myalgia and pain in various regions. Hospitalised COVID-19 was potentially linked to erectile dysfunction and alopecia areata. Very severe respiratory confirmed patients exhibited increased pain and tobacco use. Meanwhile, the MVMR analysis demonstrated a potential causal link between hospitalised COVID-19 and heart arrhythmia, and a protective effect of COVID-19 on tobacco use after adjusting for educational and income levels. Conclusions: Our MR analysis provides compelling evidence of causal associations between genetic susceptibility to COVID-19 and specific PCS symptoms, in which educational and income levels play a mediating role. These findings shed light on PCS pathogenesis and underscore the importance of considering social factors in its management. Tailored interventions and policies are crucial for PCS-affected individuals' well-being. Further research is needed to explore the impact of social determinants on COVID-19 patients and the wider population.

Green technologies, government stability, and green energy transition in a globalized world: evidence from E-7 nations.

Unsustainable development and rising environmental degradation are major challenges for emerging nations that tend to promote human welfare by expanding economic development. Green energy transition (GETR) can help these nations to continue their development, reduce fossil fuel utilization, and achieve environmental sustainability. However, previous literature overlooks the importance of green technologies, government stability, and economic globalization in the GETR process. Accordingly, this research takes a step forward and assesses the impacts of green technologies (GT), government stability (GOV), and economic globalization (EGL) on green energy transition including population density (POP) and economic growth (GDP) in emerging seven (E-7) countries from 1992 to 2020. The research applied the "continuously updated fully modified (CuP-FM)" methodology to acquire the long-run findings robust to endogeneity stationary regressors, autocorrelation, and cross-sectional dependence (CD). The results highlighted that green technologies can be enhanced to accelerate the energy transition process since GETR and green technologies are positively connected. Also, government stability and economic globalization support the green energy transition. However, both population density and economic growth obstruct the energy transition process. The Emirmahmutoglu and Kose test unveiled that green technologies, economic globalization, and government stability Granger cause the green energy transition. Based on these findings, policies are directed to promote the GETR by enhancing green technologies, economic globalization, and government stability for achieving ecological sustainability.

The construction of green finance and high-quality economic development under China's SDGs target.

The study of top economic growth with the goal of Sustainable Development Goals (SDGs) has become an important issue in the world, and scholars have analyzed high-quality economic development(HED) influencing factors from many perspectives, but there are few studies on green finance(GF) and high-quality economic development(HED). we examine the logical link between green financing and high-quality economic development, as well as the transmission mechanism behind this relationship. Using data from 30 Chinese regions from 2011 to 2021, our empirical study shows that green financing may improve high-quality economic development. Several robustness tests show that this association exists. Furthermore, our findings indicate that more robust government governance and market synergy may promote green finance for high-quality economic development. Green finance can enhance high-quality economic development by minimizing resource mismatch and encouraging green technology advancement. Simultaneously, green finance for high-quality economic development is significantly heterogeneous. Green credit and green insurance are important forms of support for promoting high-quality economic development, with significantly higher impacts in the eastern regions than in the central and western regions. Our research offers policymakers insights on encouraging green finance growth in China.

Dynamic game and simulation for low-carbon development of industrial land under the Chinese decentralization: a case study in Beijing-Tianjin-Hebei region.

To achieve low-carbon development of industrial land in China, it is important to coordinate the conflicts of interest among stakeholders in the process of land expropriation and utilization. However, the complex interaction mechanism and influencing factors among stakeholders make it difficult to achieve the goal under the Chinese decentralization and unique land development pattern. To solve these problems, this paper first analyzes the four main stakeholders' conflicts of interest in the process of land expropriation and utilization, that is, the central government, local government, peasant, and enterprise. Then, we construct two evolutionary game models to examine the dynamic changes of stakeholders' different strategies and take the Beijing-Tianjin-Hebei region as an example to compare the impacts of factors on strategies under different conditions using simulation analysis. The research shows that under the Chinese decentralization, adjusting the action strengths of different stakeholders can have different effects on system equilibrium. In terms of the central government's reward and penalty, increasing the reward and penalty for local government will shorten the time of system equilibrium to a different degree, and there is little difference between the effects of political and economic penalties. Interestingly, increasing the incentives for peasants cannot promote the system equilibrium in advance. In addition, the key to local governments' decision on illegal land expropriation lies in benefits rather than costs, and investment in low-carbon technology reform with positive externalities is easier to control than investment in economic production with negative externalities associated with pollution emissions.

Comparative review on microbial electrochemical technologies for resource recovery from wastewater towards circular economy and carbon neutrality.

Newly arising concepts such as the circular economy and carbon neutrality motivate resource recovery from wastewater. This paper reviews and discusses state-of-the-art microbial electrochemical technologies (METs), specifically microbial fuel cells (MFCs), microbial electrolysis cells (MECs) and microbial recycling cells (MRCs), which enable energy generation and nutrient recovery from wastewater. Mechanisms, key factors, applications, and limitations are compared and discussed. METs are effective in energy conversion, demonstrating advantages, drawbacks and future potential as specific scenarios. MECs and MRCs exhibited greater potential for simultaneous nutrient recovery, and MRCs offer the best scaling-up potential and efficient mineral recovery. Research on METs should be more concerned with lifespan of materials, secondary pollutants reduction and scaled-up benchmark systems. More up-scaled application cases are expected for cost structures comparison and life cycle assessment of METs. This review could direct the follow-up research, development and successful implementation of METs for resource recovery from wastewater.

Quantitative analysis and risk assessment to full-size microplastics pollution in the coastal marine waters of Hong Kong.

Given the potential risk to the ecosystem, attention has increased in recent decades to the contamination of the aquatic environment by microplastics (MPs). Due to the limitations of conventional analysis methods of MPs, little is known about the size distribution and abundance of a full-size MPs from 1 µm to 5 mm. The present study quantified MPs with size ranges of 50 µm - 5 mm and 1-50 µm in the coastal marine waters from twelve locations in Hong Kong using fluorescence microscopy and flow cytometry respectively, during the end of wet (September 2021) and dry (March 2022) seasons. The average abundance of MPs with size ranges of 50 µm - 5 mm and 1-50 µm from twelve sampling locations marine surface waters were found ranging from 27 to 104 particles L-1 and 43,675-387,901 particles L-1 in the wet season respectively, and 13-36 particles L-1 and 23,178-338,604 particles L-1 in the dry season respectively. Significant temporal and spatial variations of small MPs abundance might be observed at the sampling locations, which were contributed by the influences of the estuary of Pearl River, sewage discharge points, land structure, and other anthropogenic activities. Based on the MPs abundance information, ecological risk assessment was conducted and revealed that the small MPs (< 10 µm) in coastal marine surface waters may pose potential health risks to aquatic organisms. Additional risk assessments are needed in order to determine whether or not the MPs exposure would cause health risks to the public.

Release of microplastics from breastmilk storage bags and assessment of intake by infants: A preliminary study.

The occurrence of microplastic contaminants in food intended for human consumption has been widely explored. Yet, investigations on plastic and other particle debris in baby food packaging remain scarce to date. Our study shows the release of abundant micro-sized and submicron-sized particles, floccules (<300 µm), and fragments (1-50 µm) during the simulated use of commercially available single-use breastmilk storage bags. Six best-selling products of breastmilk storage bags were selected in our study. Most of the particles released from breastmilk storage bags that were identified as plastics were found to be polyethylene (PE), polyethylene terephthalate (PET), and nylon-6 using micro-Raman spectroscopy. The weight of the particles released from three randomly selected bags of the same product type was determined to be in the range of 0.22 and 0.47 mg. Submicron-sized particles (<0.8 µm) with irregular spherical or oval shapes were present. Microplastics and other particles ingested by infants from the use of breastmilk storage bags were estimated to be 0.61-0.89 mg/day based on the average daily breastmilk intake by infants. This study provides new insights into the exposure to microplastics and other particle debris in commonly used infant products.

Effect of Combining Operating Room Nursing Based on Clinical Quantitative Assessment with WeChat Health Education on Postoperative Complications and Quality of Life of Femoral Fracture Patients Undergoing Internal Fixation.

OBJECTIVE: To explore the effect of combining operating room nursing based on clinical quantitative assessment with WeChat health education on postoperative complications and quality of life (QOL) of femoral fracture patients undergoing internal fixation. METHODS: Ninety femoral fracture patients treated in our hospital (July 2018 to July 2021) were chosen as the research objects and split into the control group (routine intervention) and the study group (combination of operating room nursing based on clinical quantitative assessment and WeChat health education) according to the nursing intervention modes, with 45 cases each. After nursing, the postoperative complications and QOL of patients were compared between the two groups. RESULTS: No statistical between-group differences in general data were observed (P > 0.05); the hospital stay, weight-bearing time, and fracture healing time were obviously shorter in the study group than in the control group (P < 0.05); 1 d after surgery, the VAS pain status was not significantly different between the two groups (P > 0.05), and 2 d and 3 d after surgery, the VAS scores were significantly lower in the study group than in the control group (P < 0.05); 1 d after surgery, the Harris scores of patients in the two groups were close and did not present statistical difference (P > 0.05), and 8 weeks after surgery, the Harris score was significantly higher in the study group than in the control group (P < 0.05); the scores on self-care agency such as self-concept, self-care skills, sense of self-care responsibility, and health knowledge level were significantly higher in the study group than in the control group (P < 0.05); compared with the control group, the probability of occurring incision infection, lung infection, pressure sore, swelling and pain, and other complications was significantly lower in the study group (P < 0.05). CONCLUSION: Implementing operating room nursing based on clinical quantitative assessment combined with WeChat health education to femoral fracture patients undergoing internal fixation can effectively improve their postoperative clinical indicators, reduce their postoperative pain sensation and complication incidence, and effectively promote the joint motion range, which is conducive to enhancing their self-care agency and QOL.

Spatiotemporal PM2.5 estimations in China from 2015 to 2020 using an improved gradient boosting decision tree.

Fine particulate matter (PM2.5) with spatiotemporal continuity can provide important basis for the assessment of adverse effects on human health. In recent years, researchers have done a lot of work on the surface PM2.5 simulation. However, due to the limitations of data and models, it is difficult to accurately evaluate the spatial and temporal PM2.5 variations on a fine scale. In this study, we adopted the multi-angle implementation of atmospheric correction (MAIAC) aerosol products, and proposed a spatiotemporal model based on the gradient boosting decision tree (GBDT) algorithm to retrieve PM2.5 concentration across China from 2015 to 2020 at 1-km resolution. Our model achieved excellent performance, with overall CV-R2 of 0.92, and annual CV-R2 of 0.90-0.93. In addition, the model can also be used for evaluation on different time scales. Compared with previous studies, the model developed in our study performed better and more stable, which showed the highest accuracies in PM2.5 estimation works at 1-km resolution. During the study period, the overall national PM2.5 pollution showed a downward trend, with the annual mean concentration dropping from 42.42 µg/m3 to 27.91 µg/m3. The largest decrease occurred in Beijing-Tianjin-Hebei (BTH), with a trend of -5.17 µg/m3/yr, while it remains the most polluted region. The area meeting the secondary national air quality standard (<35 µg/m3) increased from ∼34% to ∼79%. These results indicate that the atmospheric environment has improved significantly. Moreover, different regions have different time nodes for the start of the continuous standard-met day during the year, and the duration is different as well. Overall, this study can provide reliable large-scale PM2.5 estimations.

TikTok and adolescent vision health: Content and information quality assessment of the top short videos related to myopia.

Background: Despite the increasing recognition of the public health value of social media platforms, TikTok short videos focusing on adolescent vision health have not received much attention. We aimed to evaluate the content, sources, and information quality of myopia-related videos on TikTok. Methods: The top 200 most-liked myopia-related videos on the Chinese version of TikTok were queried and screened on March 12, 2022. The descriptive characteristics, contents, and sources of the selected 168 videos were obtained, and their overall quality, reliability, understandability, and actionability were assessed using the validated scoring instruments DISCERN and PEMAT-A/V. Results: Medical professionals were the main source (45.8%, 77/168) of videos. Misinformation (10.1%, 17/168) was mainly attributable to for-profit organizations (20%, 3/15) and individual non-medical users (31.3%, 10/32). However, their videos enjoyed the highest numbers of "likes," "comments," and "shares" (P < 0.05). The mean reliability and overall quality regarding treatment choice were (2.5 ± 0.5) and (3.1 ± 0.9), respectively. Videos on TikTok showed relatively high understandability (84.7%) and moderate actionability (74.9%). Video producers tended to partly or fully provide information regarding management (81.5%, 137/168) and outcome (82.1%, 138/168), and to ignore or only slightly mention content related to definition (86.9%, 146/169) and signs (82.1%, 138/168). The five video sources showed significant differences in the prevalence of misleading information (P < 0.001), publication reliability (P < 0.001), overall quality (P = 0.039), content score (P = 0.019), and understandability (P = 0.024). Conclusion: Considering the moderate-to-poor reliability and variable quality across video sources, the substantial myopia-related content on TikTok should be treated with caution. Nevertheless, TikTok videos may serve as a surrogate or supplement for information dissemination if providers can ensure more comprehensive and accurate content.

Clinical Benefit of Therapeutic Drug Monitoring in Colorectal Cancer Patients Who Received Fluorouracil-Based Chemotherapy.

BACKGROUND The impact of therapeutic drug management (TDM) on reducing toxicity and improving efficacy in colorectal cancer (CRC) patients receiving fluorouracil-based chemotherapy is still unclear. MATERIAL AND METHODS A total of 207 patients (Study Group n=54, Historical Group n=153) with metastatic colorectal cancer were enrolled. All of them received 6 administrations of the 5-FU based regimens. Initial 5-FU dosing of all patients was calculated using body surface area (BSA). In the Study Group, individual exposure during each cycle was measured using a nanoparticle immunoassay, and the 5-FU blood concentration was calculated using the area under the curve (AUC). We adjusted the 5-FU infusion dose of the next cycle based on the AUC data of the previous cycle to achieve the target of 20-30 mg×h/L. RESULTS In the fourth cycle, patients in the target concentration range (AUC mean, 26.3 mg×h/L; Median, 28 mg×h/L; Range, 14-38 mg×h/L; CV, 22.4%) accounted for 46.8% of all patients, which were more than the ones in the first cycle (P<0.001). 5-FU TDM significantly reduced the toxicity of chemotherapy and improved its efficacy. The Study Group (30/289) showed a lower percentage of severe adverse events than that in the Historical Group (185/447) (P<0.001). The incidences of complete response and partial response in the Study Group were higher than those in the Historical Group (P=0.032). CONCLUSIONS TDM in colorectal cancer can reduce toxicity, improve efficacy and clinical outcome, and can be routinely used in 5-FU-based chemotherapy.

Nonconformist tendencies related to risky choices in female methamphetamine abstainers.

Background: Many experimental studies and theoretical models have tried to explain the multifaceted formation of drug addiction. In most addiction models, social factors are an important component; however, few empirical studies have investigated the social influences on the safe or risky choices of drug-addicted individuals during the abstinence stage. Objectives: To investigate the behavioral patterns of female methamphetamine abstainers under social influence. Methods: Thirty-seven female methamphetamine abstainers (average abstinence time: 8.61 ± 4.75 months) and 40 matched controls performed a gambling task in the presence of peers' choices. We applied both model-free and computational model-based analysis to examine how the decision patterns differed with social influence between the two groups. Results: 1) the choice data from the two groups showed a social influence effect such that participants made more risky choices when others made risky choices; 2) overall, the female methamphetamine abstainers made more risky choices in the social influence task; and 3) in the computational model parameters, the female methamphetamine abstainers exhibited more nonconforming attitudes (with negative other-conferred utility) with respect to peer influence, whereas controls showed higher conformity to peers. Conclusion: Our findings provide the first objective evidence that female methamphetamine abstainers show peer nonconformity. This nonconformist tendency may be a potential behavioral marker to track drug addiction and help to elucidate the mechanisms of decisions made by female methamphetamine abstainers.

New warfarin anticoagulation management model after heart valve surgery: rationale and design of a prospective, multicentre, randomised trial to compare an internet-based warfarin anticoagulation management model with the traditional warfarin management model.

INTRODUCTION: Warfarin is an effective anticoagulant and the only oral anticoagulant available for patients with mechanical heart valves. The prothrombin time and the associated international normalised ratio (INR) are routinely tested to monitor the response to anticoagulation therapy in patients. Patients who undergo mechanical heart valve replacement need lifelong anticoagulation therapy, and their INR is regularly measured to adjust the anticoagulation strength and the dose of anticoagulation drugs. Appropriate warfarin anticoagulation management can reduce patient complications, such as bleeding and thrombosis, and improve the long-term survival rate. We propose modern internet technology as a platform to build a warfarin anticoagulation follow-up system after valve replacement surgery. This system will provide doctors and patients with more standardised and safer follow-up methods as well as a method to further reduce the risk of warfarin anticoagulation-related complications and improve its therapeutic effects. METHODS AND ANALYSIS: A prospective, multicentre, randomised, controlled trial will be conducted. A total of 700 patients who require long-term warfarin anticoagulation monitoring after heart valve replacement will be enrolled and randomly divided at a 1:1 ratio into a traditional outpatient anticoagulation management group and a group undergoing a new method of management based on the internet technology with follow-up for 1 year. Differences in the percentage of time in the therapeutic range (TTR), drug dose adjustments, bleeding/thrombosis and other related complications will be observed. The primary endpoint is the difference in the TTR between the two groups. The purpose of this study is to explore a safer and more effective mode of doctor-patient interaction and communication in the internet era. As of 13 July 2019, 534 patients had been enrolled. ETHICS AND DISSEMINATION: This study protocol was approved by the Ethics Committee of Beijing Anzhen Hospital, Capital Medical University. The results will be published in a peer-reviewed medical journal. TRIAL REGISTRATION NUMBER: ChiCTR1800016204.

Optimization and Assessment of Three Different High Performance Liquid Chromatographic Systems for the Combinative Fingerprint Analysis and Multi-Ingredients Quantification of Sangju Ganmao Tablet.

Chromatographic separation is still a critical subject for the quality control of traditional Chinese medicine. In this study, three different high performance liquid chromatographic (HPLC) systems employing commercially available columns packed with 1.8, 3.5 and 5.0 µm particles were respectively developed and optimized for the combinative fingerprint analysis and multi-ingredients quantification of Sangju Ganmao tablet (SGT). Chromatographic parameters including the repeatability of retention time and peak area, symmetry factor, resolution, number of theoretical plates and peak capacity were used to assess the chromatographic performance of different HPLC systems. The optimal chromatographic system using Agilent ZORBAX SB-C18 column (2.1 mm × 100 mm, 3.5 µm) as stationary phase was respectively coupled with diode array detector or mass spectrometry detector for the chromatographic fingerprint analysis and simultaneous quantification or identification of nine compounds of SGT. All the validation data conformed to the acceptable requirements. For the fingerprint analysis, 31 peaks were selected as the common peaks to evaluate the similarities of SGT from 10 different manufacturers using heatmap, hierarchical cluster analysis and principal component analysis. The results demonstrated that the combinations of the quantitative and chromatographic fingerprint analysis offer an efficient way to evaluate the quality consistency of SGT.

Montreal cognitive assessment and analysis of related factors for cognitive impairment in patients with chronic cerebral circulation insufficiency.

BACKGROUND: Chronic cerebral circulation insufficiency (CCCI) refers to cerebral dysfunctions that lead to cerebral vascular pathological changes. Our aim is to identify factors related to cognitive impairment in CCCI. METHODS: CCCI patients (n=102) were assessed with the Montreal cognitive assessment (MoCA) to analyze cognitive impairment. Patients were divided into two groups according to MoCA scores: (1) cognitive dysfunction and (2) normal cognitive function. We compared the clinical information with univariate and multivariate logistic regression analyses and identified major risk factors related to cognitive impairment in CCCI. RESULTS: Age (p=0.007, OR=3.768, χ2=7.173), leukoaraiosis (p=0.002, OR=6.231, χ2=9.478), a history of hypertension (p=0.021, OR=3.078, χ2=5.307), a history of hyperlipidemia (p=0.016, OR=3.429, χ2=5.795), and the number of vascular risk factors (p=0.019, χ2=9.921) were related to cognitive impairment by univariate analysis. Age (p=0.070, OR=2.689, 95% CI=0.923±7.837) and leukoaraiosis (p=0.012, OR=4.531, 95% CI=1.401±14.667) were significant by multivariate logistic regression analysis. Age (r=-0.585, p<0.01) had a marked negative correlation with MoCA scores. There were significant differences in the MoCA subscale scores, including visuospatial and executive capacity (p<0.01), attention and calculation (p<0.01), and delayed recall (p<0.01), in patients with different degrees of leukoaraiosis. Patients with CCCI had a higher incidence of cognitive impairment (78.4%). CONCLUSIONS: Changes in visuospatial and executive capacity, delayed recall, and language function represent cognitive manifestations in CCCI. Age and leukoaraiosis have the strongest effects on cognitive impairment morbidity and can aggravate cognitive impairment.

Assessment of renal tissue elasticity by acoustic radiation force impulse quantification with histopathological correlation: preliminary experience in chronic kidney disease.

OBJECTIVES: Chronic kidney disease (CKD), a progressive and irreversible pathological syndrome, is the major cause of renal failure. Renal fibrosis is the principal process underlying the progression of CKD. Acoustic radiation force impulse (ARFI) quantification is a promising noninvasive method for assessing tissue stiffness. We evaluated whether the technique could reveal renal tissue fibrosis in CKD patients. METHODS: ARFI assessments were performed in 45 patients with CKD referred for renal biopsies to measure cortical shear wave velocity (SWV). During measurement, a standardized method was employed, which aimed to minimize the potential impact of variation of transducer force, sampling error of non-cortical tissue and structural anisotropy of the kidney. Then SWV was compared to patients' CKD stage and pathological fibrosis indicators. RESULTS: ARFI could not predict the different stages of CKD. Spearman correlation analysis showed that SWV did not correlate with any pathological indicators of fibrosis. CONCLUSION: ARFI assesses tissue stiffness of CKD kidneys by measuring cortical SWV. However, SWV did not show significant correlations with CKD stage and fibrosis indicators despite using standardized measurement methods. We therefore suggest that it would be necessary to evaluate the effect of pathological complexity and tissue perfusion of the kidney on stiffness assessment in future studies. KEY POINTS: • Acoustic radiation force impulse (ARFI) can quantify tissue elasticity of CKD kidney. • Despite standardized measurement, ARFI-estimated elasticity did not correlate with renal fibrosis. • Effects of pathological complexity and tissue perfusion on renal stiffness warrant further study.

A mortality risk assessment model for cardiac valve replacement surgery and its application in the use of prophylactic extracorporeal membrane oxygenation.

This study was conducted to establish a quantitative model to predict the risk of in-hospital mortality for patients undergoing cardiac valve replacement and to decrease mortality in patients with predicted high risk using prophylactic extracorporeal membrane oxygenation (PECMO). We retrospectively reviewed the medical records of 4482 patients who underwent cardiac valve replacement from January 1994 to December 2004, at Anzhen Hospital, Beijing, China. A total of 158 patients were going to receive heart valve replacement. Associations between mortality and the demographic, clinical, and laboratory variables of patients were first assessed using univariate analysis. Six of 7 variables in the univariate analysis were statistically significant and were included in the multivariate analysis: renal function; age; left ventricular ejection fraction (EF); coronary artery disease (CAD); pulmonary artery pressure (PAP); and left ventricular end-diastolic diameter (LVEDD). The area under the receiver operating characteristic (ROC) curve (AUC) was 73.58%. Observed mortality in the group with PECMO (5.45%, 3/55) was significantly lower (Pearson Chi2 = 4.314, P = 0.038, P < 0.05) than in the group without PECMO (24.27%, 25/103). With the use of our scoring model, the risk of postoperative mortality in patients planning to undergo valve replacement can be predicted before the procedure is performed. For patients with predicted mortality greater than 10%, the use of PECMO during surgery, in addition to extracorporeal circulation, was found to decrease mortality.